Bottle-Feeding (Formula) Questions

Is this your child's symptom?

Breastfed, see

Topics Coveredfor Formula Feeding

If your baby is healthy, skip the "What to Do" section. Go directly to the topic number that relates to your question for advice:

Types of formulas

Switching formulas and milk allergies

Powdered versus liquid formulas

Whole cow's milk, 2%, 1% and skim milk

Vitamins and iron

Water to mix with the formula

Extra water

Amounts: How much per feeding?

Schedules or frequency of feedings

Length of feedings

Night feedings: How to eliminate?

Formula temperature

Formula storage

Cereals and other solids

Burping

Baby bottle tooth decay

Traveling

Nipples and bottles

Normal stools

Breast discomfort

When to Call for Bottle-Feeding (Formula) Questions

Call 911 Now

Can't wake up

Not moving or very weak

You think your child has a life-threatening emergency

Call Doctor Now or Go to ER

Hard to wake up

Too weak to suck

Age under 1 month old and looks or acts abnormal in any way

Dehydration suspected. (No urine in over 8 hours, dark urine, very dry mouth and no tears)

Will not drink or drinks very little for over 8 hours

Age under 12 weeks old with fever. (Caution: Do NOT give your baby any fever medicine before being seen)

Your child looks or acts very sick

You think your child needs to be seen, and the problem is urgent

Call Doctor Within 24 Hours

Does not seem to be gaining enough weight

You think your child needs to be seen, but the problem is not urgent

Call Doctor During Office Hours

You have other questions or concerns

Self Care at Home

Bottle-feeding question about a healthy baby

Call 911 Now

Can't wake up

Not moving or very weak

You think your child has a life-threatening emergency

Call Doctor Now or Go to ER

Hard to wake up

Too weak to suck

Age under 1 month old and looks or acts abnormal in any way

Dehydration suspected. (No urine in over 8 hours, dark urine, very dry mouth and no tears)

Will not drink or drinks very little for over 8 hours

Age under 12 weeks old with fever. (Caution: Do NOT give your baby any fever medicine before being seen)

Your child looks or acts very sick

You think your child needs to be seen, and the problem is urgent

Call Doctor Within 24 Hours

Does not seem to be gaining enough weight

You think your child needs to be seen, but the problem is not urgent

Call Doctor During Office Hours

You have other questions or concerns

Self Care at Home

Bottle-feeding question about a healthy baby

Care Advice for Bottle (Formula) Feeding

Types of Formulas:

Milk-protein formulas, soy-protein formulas, and hydrolysate formulas

Soy formulas don't contain lactose or cow's milk protein. Currently, 20% of infants in the U.S. are fed soy formula. Often, switching to soy is not done with a valid reason.

Hydrolysate formulas mean the protein is broken down. These are advised when children are sensitive to both soy and milk protein.

Switching Formulas and Milk Allergies:

Switching from one milk-based formula to another is not helpful for any symptom. It is also not harmful.

Switching from milk formula to soy formula is sometimes helpful for severe diarrhea. This may occur from temporary low lactase levels. It may also be used for those families who are vegetarian.

Switching from milk formula to soy is sometimes helpful for cow's milk allergy. A cow's milk allergy occurs in 1-2% of infants. Most often, protein hydrolysate formulas (such as Alimentum) are advised. This is because 15% of these infants are also allergic to soy protein.

Switching formulas for frequent crying, spitting up or gas is rarely helpful.

Cow's milk should not be given to babies before 12 months of age. Reason: Raises risk of iron deficiency anemia and allergies.

Skim milk (fat free milk), 1% low fat milk or 2% milk should not be used before 2 years. Reason: The fat content of whole cow's milk (3.5%) is required. It is needed for rapid brain growth.

Vitamins and Iron:

For all infants, use a formula that has iron in it. This helps to prevent iron deficiency anemia.

The iron amount in iron-fortified formulas is too small to cause any symptoms. Iron in formulas does not cause constipation or diarrhea.

Iron-fortified formulas contain all the vitamins and minerals needed except for fluoride.

Extra vitamins are therefore not needed for infants taking formula.

From 6 months to 16 years of age, some children need fluoride supplements. Fluoride is needed to prevent tooth decay. This is a prescription drug. If a prescription is needed, discuss with your child's doctor during office hours. Exception: Fluoride present in child's water supply in most cities. Your infant will get enough if city water is used to mix the formula.

Water to Mix With the Formula:

Most city water supplies are safe for making 1 bottle at a time. Run the cold tap water for 1 minute. Don't use warm tap water. (Reason: To avoid potential lead exposure). Heat cold water to desired temperature. Add this to powder or formula concentrate.

Exceptions:

Untested well water or

City water with recent contamination or

Developing countries with unsafe water supply or

Your child has decreased immunity.

For these conditions, use distilled water, bottled water, or filtered tap water.

Another option is to use city water or well water that has been boiled. Boil for 10 minutes. Add 1 extra minute per each 1,000 feet (305 meters) of elevation.

Bottled water costs more than distilled water.

If making a batch of formula, distilled, bottled or boiled water is needed.

Extra Water:

Babies usually do not need extra water. (Reason: regular formula is 85% water)

Too much water can cause seizures.

You can offer some water if weather is very hot.

Don't give more than 4 ounces (120 ml) of extra water per day. Limit extra water during the first 6 months of life. Exception: Don't give any during the first month.

After starting solid foods, babies need more water.

Amounts - How Much Per Feeding:

The average amount of formula that babies take per feeding is:

Newborn: 2-3 ounces (60-90 ml) per feeding

1 month old: 4 ounces (120 ml) per feeding

2 months old: 5 ounces (150 ml) per feeding

4 months old: 6 ounces (180 ml) per feeding

6 months old: 7-8 ounces (210-240 ml) per feeding

The amount can vary depending on the baby's weight and if the baby is going through a growth spurt.

A baby's appetite varies throughout the day. If the infant stops feeding or loses interest, the feeding should be stopped.

If healthy babies are not hungry at several feedings, increase the feeding interval.

During daytime, your baby shouldn't sleep for more than 3 hours at a time. If your baby naps longer than that, wake him for a feeding.

Place your baby in the crib drowsy but awake. Don't bottle-feed or rock until asleep.

Make middle-of-the-night feedings brief and boring compared to daytime feedings. Don't turn on the lights or talk to your child. Feed him rather quickly.

Formula Temperature:

Most babies like formula at body temperature.

In the summertime, some infants prefer formula that's cooler.

In the wintertime, some prefer warm formula.

The best temperature is the one your infant prefers. Either way, there's no health risk involved.

Just make sure the formula is not too hot. Reason: It can burn your baby's mouth.

Formula Storage:

If you can, make your child's formula fresh for each feed. However, if formula needs to be made ahead of time:

Prepared formula should be stored in the refrigerator. It must be used within 24 hours.

Open cans of formula should also be kept in the refrigerator. They should be covered and used within 24 hours.

Prepared formula left at room temperature for more than 1 hour should be discarded.

Leftover used formula should always be tossed. Reason: Contains germs that can grow.

Cereals and Other Solids:

Bottle-fed infants should be started on baby foods between 4 and 6 months. First baby foods can be cereals and/or fruit.

Starting before 4 months is not needed. Starting before 4 months makes feedings messier and longer. Early use of solids can also cause gagging.

Solids don't increase sleeping through the night for bottle-fed infants.

Delaying solids past 9 months of age is not advised. The delay runs the risk that your infant will refuse solids.

Burping:

It is not harmful if a baby doesn't burp.

Burping is an option, but not required.

It can decrease spitting up, but it doesn't lessen crying.

Burping can be done twice per feeding, once midway and once at the end.

If your baby does not burp after 1 minute of patting, it can be stopped.

Baby Bottle Tooth Decay:

Some older infants and toddlers are used to a bottle before sleeping.

Falling asleep with a bottle of milk or juice can cause severe tooth decay.

Prevent this bad habit by not using the bottle as a pacifier. Also, do not use the bottle as a security object.

If you cannot stop the bottles, fill it with water. Use water instead of formula or milk at bedtime.

Traveling:

Use bottles of ready-to-feed formula (most expensive).

Or mix formula ahead of travel and carry in a cold insulated container.

Or use powered formula. Put the required number of scoops in a bottle. Carry clean water in a separate bottle. Mix before each feeding.

Nipples and Bottles:

Any nipple/bottle products are fine.

It is not necessary to sterilize bottles or nipples. Wash them with soap and water. Rinse them thoroughly.

It is also safe to wash bottles and nipples in the dishwasher.

Formula-fed Stools, Normal:

Meconium Stools are dark greenish-black, thick and sticky. They normally are passed during the first 3 days of life.

Transitional Stools are a mix of meconium and milk stools. They are greenish-brown and looser. They are passed day 4 to 5 of life.

Normal Milk Stools without any meconium are seen from day 6 on.

Formula-fed babies pass 1 to 8 stools per day during the first week. Then it starts to slow down to 1 to 4 per day. This lasts until 2 months of age.

The stools are yellow in color and thick like peanut butter. Green stools are also normal (usually caused by bile).

After 2 months of age, most babies pass 1 or 2 stools per day. They can also pass 1 every other day. They are soft and solid.

Breast Discomfort In Bottle-feeding Mothers:

Even though you chose not to breastfeed, your breasts will make milk. Breast milk comes in on day 2 or 3. Swollen breasts can be painful for a few days. Here is what to do:

Ibuprofen. Take 400 mg of ibuprofen (such as Advil) 3 times per day. This will help to lessen pain and swelling. There's no special prescription medicine for this.

Cold Pack. Use a cold pack or ice bag wrapped in a wet cloth. Put it on your breasts for 20 minutes. Do this as often as needed. This will decrease milk production. Do not use heat. Heat will increase milk production.

Pumping. For moderate pain, hand express or pump off a little breast milk. This will help to reduce your pain. Pumping breast milk can increase milk production. But, doing this to take the edge off your discomfort is not harmful.

Bra. Wear a bra that offers good breast support or a sports bra. Wear it 24 hours a day.

Binding. Binding the breasts by wearing a tight bra is no longer advised. Binding by using an elastic wrap is also not advised. Binding can increase the risk of breast infections (mastitis).

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

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